Wang Yi, Zhang Xiyan, Li Yan, Qin Hongyun, Li Xin
Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China.
Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Front Public Health. 2024 Dec 6;12:1436413. doi: 10.3389/fpubh.2024.1436413. eCollection 2024.
Prior studies have reported gender differences in the prevalence, comorbidity rates and related factors of depression during adolescence. But the gender differences in depression vary across studies. Besides, the evidence from Chinese adolescent samples is limited. This study aimed to explore gender differences in the depression-related factors, the potential interactions of the associated factors and clinical features of comorbid depression and anxiety among Chinese adolescents.
A cross-sectional study involving 3,510 participants aged 11 to 16 years from schools (private and public) in Shanghai was conducted with an anonymous paper-and-pencil questionnaire. Children's Depression Inventory (CDI), Child Anxiety Related Emotional Disorders (SCARED), Strengths and Difficulties Questionnaire (SDQ) were used to evaluate depression, anxiety and behavioral and emotional difficulties, respectively. Logistic regression model was used to explore the possible correlated factors of adolescent depression and analyze the interactions of the risk factors.
Our results showed that there was no gender difference in the prevalence rates of depression ( = 0.047, = 0.83), but the prevalence of depression in females began to exceed that of males at the ages of 15 and 16. The factors associated with depression varied by gender. Private school was a risk factor for depression only in boys (adjusted OR = 1.842 [95% CI, 1.286-2.636]), whereas girls from nuclear families (adjusted OR = 1.631 [95% CI, 1.156-2.300]) and other family structures (adjusted OR = 2.682 [95% CI, 1.502-4.788]) were more likely to experience depression compared to their peers in extended family structures. Interaction analyses showed there was a negative interaction between abnormal peer problems and 7th grade among boys (adjusted OR = 0.288 [95% CI, 0.086-0.951]). Furthermore, comorbidity rates of depression and anxiety were higher in girls than that in boys ( = 14.457, < 0.001). And girls with comorbidity showed increased SDQ peer problems scores ( = -3.151, = 0.002).
The findings indicate it is important to develop gender-specific interventions for adolescent depression. And for boys, evaluating peer relationships may be particularly crucial in lower grades. Moreover, recognizing the gender-specific clinical features of comorbid depression and anxiety is important for appropriate clinical diagnosis and targeted treatment.
先前的研究报告了青春期抑郁症的患病率、合并症发生率及相关因素存在性别差异。但抑郁症的性别差异在不同研究中有所不同。此外，来自中国青少年样本的证据有限。本研究旨在探讨中国青少年抑郁症相关因素的性别差异、相关因素的潜在相互作用以及合并抑郁症和焦虑症的临床特征。
采用匿名纸笔问卷对上海私立和公立学校的3510名11至16岁参与者进行横断面研究。分别使用儿童抑郁量表（CDI）、儿童焦虑相关情绪障碍量表（SCARED）、长处和困难问卷（SDQ）来评估抑郁、焦虑以及行为和情绪问题。采用逻辑回归模型探讨青少年抑郁症可能的相关因素，并分析危险因素的相互作用。
我们的结果显示，抑郁症患病率无性别差异（χ² = 0.047，P = 0.83），但在15岁和16岁时，女性抑郁症患病率开始超过男性。与抑郁症相关的因素因性别而异。私立学校仅为男孩患抑郁症的危险因素（调整后OR = 1.842 [95%CI，1.286 - 2.636]），而与大家庭结构中的同龄人相比，核心家庭的女孩（调整后OR = 1.631 [95%CI，1.156 - 2.300]）和其他家庭结构的女孩（调整后OR = 2.682 [95%CI，1.502 - 4.788]）更易患抑郁症。交互分析显示，男孩中异常同伴问题与七年级之间存在负向交互作用（调整后OR = 0.288 [95%CI，0.086 - 0.951]）。此外，女孩中抑郁症和焦虑症的合并症发生率高于男孩（χ² = 14.457，P < 0.001）。合并症女孩的SDQ同伴问题得分增加（t = -3.151，P = 0.002）。
研究结果表明，针对青少年抑郁症开展针对性别的干预措施很重要。对于男孩，在较低年级评估同伴关系可能尤为关键。此外，认识到合并抑郁症和焦虑症的性别特异性临床特征对于适当的临床诊断和靶向治疗很重要。
